Provider Demographics
NPI:1730594870
Name:CARMICHAELS OF COVINGTON INC
Entity type:Organization
Organization Name:CARMICHAELS OF COVINGTON INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-317-2850
Mailing Address - Street 1:PO BOX 965
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-0965
Mailing Address - Country:US
Mailing Address - Phone:770-267-2559
Mailing Address - Fax:770-267-6138
Practice Address - Street 1:9148 HIGHWAY 278 NE STE D
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-7032
Practice Address - Country:US
Practice Address - Phone:678-712-4570
Practice Address - Fax:678-712-4558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-27
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0100373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146549OtherPK